A Brief Tool to Screen Patients for Precarious Employment: A Validation Study
Precarious employment, defined by temporary contracts or job insecurity, is becoming more common and often linked to worse health outcomes and higher workplace stress. This study developed a simple three-question tool to screen for precarious employment among patients in primary care: 1) Are you currently employed in a casual, short-term or temporary position? 2) Do you feel fearful that you could be fired if you raised employment concerns? 3) Does your pay vary a lot from month to month?
To validate the tool, 200 patients at seven Toronto clinics in areas with higher poverty rates than the rest of the city participated in the study. They completed the three-item questionnaire alongside the Poverty and Employment Precarity in Southern Ontario (PEPSO) Employment Precarity Index, an established measure for identifying precarious employment. Patients who answered ‘yes’ to 2-3 screening questions were almost four times more likely to be precariously employed based on their PEPSO scores.
Identifying whether patients face precarious employment is crucial in primary care settings. Clinicians can refer patients to programs that will help them understand their rights at work, actions to take when confronted with health or safety challenges, and pathways to seek new employment. A positive screen also provides more context on how work conditions may affect symptoms, such as exposure to physical hazards and mental health concerns.
Precarious employment is an important social determinant of health that may be less apparent without a detailed social history, which is sometimes difficult to obtain in busy primary care settings. The study provides a simple tool for screening precarious employment, supporting clinicians to refer patients to services and tailor treatment plans accordingly. Moreover, the data from this study can support policy reforms to reduce precarious employment.